New-onset refractory status epilepticus: Etiology, clinical features, and outcome.
Details
Serval ID
serval:BIB_9D7354ED476D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
New-onset refractory status epilepticus: Etiology, clinical features, and outcome.
Journal
Neurology
Working group(s)
Critical Care EEG Monitoring Research Consortium (CCEMRC), Critical Care EEG Monitoring Research Consortium CCEMRC
Contributor(s)
Fertig E., Herman ST., Huh L., Lee JW., Loddenkemper T., Chapman K., Abend NS., Carpenter J., Hantus S., Claassen J., Husain AM., Gaspard N., LaRoche SM., Ritzl EK., Gofton T., Wusthoff C., Goldstein J., Westover BM., Hocker S., Halford J., Jones J., Gerard EE., Schmitt SE., Williams K., Hahn CD., Szaflarski JP., Kramer A., Rudzinski L., Hopp J., Mani R., Kalamangalam GP., Gupta P., Quigg MS., Haas KF., Ostendorf A., Zutshi D., Hirsch LJ.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
85
Number
18
Pages
1604-1613
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
OBJECTIVES: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.
METHODS: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).
RESULTS: Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes.
CONCLUSIONS: Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation.
METHODS: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).
RESULTS: Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes.
CONCLUSIONS: Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation.
Pubmed
Web of science
Create date
01/12/2015 18:43
Last modification date
20/08/2019 16:03
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